HPB Flashcards
Complications of gallstones?
gallbladder:
biliary colic
cholecystitis
mucocele
empyema
gangrenous
perforation
gallbladder malignancy
Mirizzi’s syndrome
CBD:
cholangitis
pancreatitis
gut:
gallstone ileus
Bouveret syndrome
What is cholelithiasis?
presence of gallstones
What is choledocholithiasis?
gallstones obstructing the bile duct
RFs for gallstones?
fair
female
fat
forty
fertile
(high oestrogen state)
Why does biliary colic occur?
when fat enters the digestive system it causes cholecystokinin release from the duodenum
this causes the gallbladder to contract which causes the symptoms of biliary colic
US findings in gallstone disease?
gallstones in the gallbladder (hyperechoic with acoustic shadow)
gallstones in duct
bile duct dilatation
thickened wall
sludge
fluid around the gallbladder
What can be performed during an ECRP?
sphincterotomy of sphincter of Oddi if dysfunctional
clear stones from the ducts
insert stents
take biopsies
Complications of ERCP?
excessive bleeding
pancreatitis
cholangitis
Scar associated with open cholecystectomy?
Kocher incision
right subcostal
rare these days because laparoscopic sx preferred
Complications of cholecystectomy?
bile leak
stones left in the bile duct
strictures
post-cholecystectomy syndrome
What is post-cholecystectomy syndrome?
diarrhoea
indigestion
epigastric or RUQ pain
nausea
intolerance of fatty foods
flatulence
improve by themselves with time
Types of cholecystitis?
calculous (95%)
acalculous
Causes of calculous cholecystitis?
inflammation of the gallbladder caused by blockage of the neck of the gallbladder or the cystic duct by gallstones
Causes of acalculous cholecystitis?
build-up of pressure in the gallbladder due to long periods of fasting or TPN resulting in the gallbladder not contracting
Signs of acute cholecystitis on US?
thickened gallbladder wall
stones or sludge in the gallbladder
fluid surrounding the gallbladder
Mx of acute cholecystitis?
nil by mouth
IV fluids
IV Abx (ceftriaxone + metronidazole)
laparoscopic cholecystectomy
What is biliary colic?
temporary impaction of gallstones in Hartmann’s pouch or the cystic duct
What is gallstone ileus?
when a gallstone erodes into the small bowel wall causing a cholecysto-duodenal fistula and travels through resulting in a small bowel obstruction
What is Bouveret’s syndrome?
when a gallstone erodes into the duodenum causing a cholecysto-duodenal fistula and lodges there, resulting in a gastric outlet obstruction
What is Mirizzi’s syndrome?
a large stone in the cystic duct or Hartman’s pouch compresses the adjacent common hepatic duct
causes jaundice
What is Rigler’s triad?
pneumobilia
ectopic calcified gallstone, usually in RIF
SBO
indicative of gallstone ileus
